Patient Perspectives on the Experience of Being Newly Diagnosed with HIV in the Emergency Department/Urgent Care Clinic of a Public Hospital

PURPOSE: There is little description of emergency department (ED) visits and subsequent hospitalizations among a safety-net cancer population. We characterized patterns of ED visits and explored nonclinical predictors of subsequent hospitalization, including time of ED arrival. PATIENTS AND METHODS: This was a retrospective cohort study of patients with cancer (excluding leukemia and nonmelanoma skin cancer) between 2012 and 2016 at a large county urban safety-net health system. We identified ED visits occurring within 180 days after a cancer diagnosis, along with subsequent hospitalizations (observation stay or inpatient admission). We used mixed-effects multivariable logistic regression to model hospitalization at ED disposition, accounting for variability across patients and emergency physicians. RESULTS: The 9,050 adults with cancer were 77.2% nonwhite and 55.0% female. Nearly one-quarter (24.7%) of patients had advanced-stage cancer at diagnosis, and 9.7% died within 180 days of diagnosis. These patients accrued 11,282 ED visits within 180 days of diagnosis. Most patients had at least one ED visit (57.7%); half (49.9%) occurred during business hours (Monday through Friday, 8:00 am to 4:59 pm), and half (50.4%) resulted in hospitalization. More than half (57.5%) of ED visits were for complaints that included: pain/headache, nausea/vomiting/dehydration, fever, swelling, shortness of breath/cough, and medication refill. Patients were most often discharged home when they arrived between 8:00 am and 11:59 am (adjusted odds ratio for hospitalization, 0.69; 95% CI, 0.56 to 0.84). CONCLUSION: ED visits are common among safety-net patients with newly diagnosed cancer, and hospitalizations may be influenced by nonclinical factors. The majority of ED visits made by adults with newly diagnosed cancer in a safety-net health system could potentially be routed to an alternate site of care, such as a cancer urgent care clinic.

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Impact of a Cancer Urgent Care Clinic on Regional Emergency Department Visits

Journal of Oncology Practice ◽

10.1200/jop.18.00743 ◽

2019 ◽

Vol 15 (6) ◽

pp. e501-e509

Author(s):

Arthur S. Hong ◽

Thomas Froehlich ◽

Stephanie Clayton Hobbs ◽

Simon J. Craddock Lee ◽

Ethan A. Halm

Keyword(s):

Emergency Department ◽

Emergency Department Visits ◽

Urgent Care ◽

Comprehensive Cancer Center ◽

Secondary Outcome ◽

Cancer Center ◽

Control Group ◽

Interrupted Time Series Analysis ◽

Care Clinic ◽

Urgent Care Clinic

PURPOSE: Did the creation of an urgent care clinic specifically for patients with cancer affect emergency department visits among adults newly diagnosed with cancer? PATIENTS AND METHODS: We applied an interrupted time series analysis to adjusted monthly emergency department visits made by adults age 18 years or older who were diagnosed with cancer between 2009 and 2016 at a comprehensive cancer center. Cancer registry patients were linked to a longitudinal regional database of emergency department and hospital visits. Because the urgent care clinic was closed on weekends, we took advantage of the natural experiment by comparing weekend visits as a control group. Our primary outcome was emergency department visits within 180 days after a cancer diagnosis, compiled as adjusted monthly rates of emergency department visits per 1,000 patient-months. We analyzed subsequent hospitalizations as a secondary outcome. RESULTS: The rate of weekday emergency department visits was increasing at a rate of 0.43 visits (95% CI, 0.29 to 0.57 visits) per month before May 2012, then fell in half to a rate of 0.19 visits (95% CI, 0.11 to 0.28 visits) per month ( P = .007) after the urgent care clinic was established. In contrast, the weekend visit rate was growing at a rate of 0.08 visits (95% CI, −0.03 to 0.19 visits) per month before May 2012 and 0.05 (95% CI, −0.02 to 0.13 visits; P = .533) afterward. By the end of 2016, there were 15.3 fewer monthly weekday emergency department visits than expected ( P = .005). Trends in weekday hospitalizations were not significantly changed. CONCLUSION: Although only one in eight emergency department–visiting patients also used the urgent care clinic, the growth rate of emergency department visits fell by half after the urgent care clinic was established.

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Practical Assessment and Treatment of the Patient with Headaches in the Emergency Department and Urgent Care Clinic

Neurology ◽

10.1212/wnl.0b013e31827f102d ◽

2013 ◽

Vol 80 (5) ◽

pp. 509-510

Author(s):

J. L. Beams ◽

T. D. Rozen

Keyword(s):

Emergency Department ◽

Urgent Care ◽

Care Clinic ◽

Assessment And Treatment ◽

Urgent Care Clinic

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Practical Assessment and Treatment of the Patient with Headaches in the Emergency Department and Urgent Care Clinic

10.1007/978-1-4614-0002-8 ◽

2011 ◽

Author(s):

Dawn A. Marcus ◽

Philip A. Bain

Keyword(s):

Emergency Department ◽

Urgent Care ◽

Care Clinic ◽

Assessment And Treatment ◽

Urgent Care Clinic

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Urgent care in the community: an observational study

Journal of Health Organization and Management ◽

10.1108/jhom-09-2020-0364 ◽

2021 ◽

Vol ahead-of-print (ahead-of-print) ◽

Author(s):

John Adie ◽

Wayne Graham ◽

Kerron Bromfield ◽

Bianca Maiden ◽

Sam Klaer ◽

...

Keyword(s):

Emergency Department ◽

Urgent Care ◽

Chart Audit ◽

Community Based ◽

Pathology Laboratory ◽

Care Clinic ◽

Content Type ◽

Client Group ◽

Urgent Care Clinic ◽

Electrocardiogram Ecg

PurposeThis case study describes a community-based urgent care clinic in a general practitioner (GP) super clinic in South East Queensland.Design/methodology/approachThis retrospective chart audit describes patient demographic characteristics, types of presentations and management for Sundays in 2015.FindingsThe majority of patients (97%) did not require admission to hospital or office investigations (95%) and presented with one condition (94%). Of the presentations, 66.5% were represented by 30 conditions. Most patients received a prescription (57%), some were referred to the pathology laboratory (15%) and some were referred to radiology (12%). A majority (54%) of patients presented in the first three hours. Approximately half (51%) of patients presenting were aged under 25. More females (53%) presented than males. A majority (53%) lived in the same postcode as the clinic. The three most common office tests ordered were urinalysis, electrocardiogram (ECG) and urine pregnancy test. Some patients (19%) needed procedures, and only 3% were referred to hospital.Research limitations/implicationsThe study offers analysis of the client group that can be served by an urgent care clinic in a GP super clinic on a Sunday. The study provides an option for emergency department avoidance.Originality/valueDespite calls for more research into community-based urgent care clinics, little is known in Australia about what constitutes an urgent care clinic. The study proposes a classification system for walk-in presentations to an urgent care clinic, which is comparable to emergency department presentations.

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